A study out of China evaluated the safety and efficacy of tenecteplase administered within 4.5-24 hours after the onset of stroke. Patients in the TRACE-III study had had ischemic stroke due to large-vessel occlusion, had salvageable tissue, and did not have access to endovascular thrombectomy. They were randomly assigned to receive tenecteplase at a dose of 0.25 mg per kilogram of body weight (n=264) or standard medical treatment (n=252) 4.5-24 hours after the time the individual was last known to be well. At 90 days, a higher percentage of patients in the tenecteplase group than in the standard treatment group had a modified Rankin scale score of 0 or 1 – the absence of disability, and the primary outcome, at 33.0% vs. 24.2%, respectively. Rates of mortality at 90 days were similar between the two groups: 13.3% with tenecteplase and 13.1% with standard medical treatment. However, symptomatic intracranial hemorrhage within 36 hours of treatment was higher in the tenecteplase group, at 3,0% vs. 0.8% in the standard treatment group. “In addition to the practical advantage of administration of tenecteplase as a single bolus as compared with alteplase, which is administered as an infusion, our results support the use of tenecteplase in the extended time window when endovascular thrombectomy is not immediately available,” the researchers conclude. “However, this approach requires corroboration in trials that are performed in countries in which fewer ischemic strokes are caused by atherogenesis.”